Does a diagnosis of dementia mean an immediate end to driving?

“Do I have to stop driving?”
is a frequently asked question when people first receive a diagnosis of dementia

Although driving may feel like an automatic activity to experienced motorists, it actually requires complex interactions between eyes, brain and muscles, along with rapid reaction responses to deal with unexpected circumstances. As dementia takes hold, the skills needed for driving will inevitably be impeded and, at some point, the decision will have to be made to stop driving.

The timing of this decision will be different for each individual, and if diagnosis is made early, it needn’t necessarily be at the point of diagnosis. Some drivers continue driving safely for several years after dementia has first been confirmed.

What is essential, immediately after diagnosis, is that you inform both the DVLA and your insurance company of the diagnosis – not to do so is a criminal offence and will invalidate your insurance policy leaving you uninsured.

After that, it’s a question of judging whether safety is compromised. Your GP will be able to offer advice and a special driving assessment which aims to assess the impact the dementia is having on the safety and performance of the driver may be required.

Hard as it may be to accept, the following list
provides the warning signs that it’s time to stop driving:

• Forgetting how to locate familiar places
• Failing to observe traffic signs
• Making slow or poor decisions in traffic
• Driving at an inappropriate speed
• Becoming angry or confused while driving
• Hitting curbs
• Using poor lane control
• Making errors at junctions
• Confusing the brake and gas pedals
• Returning from a routine drive later than usual
• Forgetting the destination you are driving to during the trip

Recognising these signs, some drivers quickly begin to find driving stressful and make the decision to stop relatively easily. All too often however, people with dementia tend to underestimate the impact the disease is having on their driving ability, and become angry and resentful when it is suggested they give up driving. Some even simply forget that the DVLA has ruled they must stop.

In these cases, it’s likely to fall on friends and family members to step in and take control.

Forward planning really  helps so that other transport options (such as taxis, shop-mobility, and local community transport schemes) can be explored before giving up driving entirely.

What’s important is that  loss of driving doesn’t feel like a loss of independence.
Support, patience and understanding will all be needed, but an end to driving should not feel like the end of the road.

How to make your home a dementia-friendly space

When faced with a diagnosis of dementia, one of the most immediate concerns people have is that confusion and memory loss will prevent them from continuing to live safely in their own home. Yet, with the right support, and some basic design and lay-out alterations, much can be done to transform the physical space in the home into an environment that is both safety conscious AND fosters independence.

Where to start?

Knowing where to start is probably the hardest part. When assessing your home, the 2 key questions to ask are:

What hazards exist that can easily be removed?

What adaptations can be made that will foster independence?

Using research conducted by the Dementia Services Development Centre at the University of Stirling, and the national housing charity, Care & Repair England, we’ve collected together some useful suggestions for considering possible changes.  We’ve arranged them under the 3 headings to get you started:

• General design and layout
• Lighting and heating
• Safety and security

Look at each room in turn and don’t get overwhelmed – remember even 1 or 2 small changes can have a significant impact.

 The Design and Layout of your home:

Hazards:

• Consider the layout of each room. Simply eliminating clutter and unneeded furniture can make route-ways to and from the door, or across the room, more readily recognisable, and ensure movement is easier and safer.
• Mirrors can cause confusion, particularly as the dementia progresses, so covering or moving them may help.
• Closed doors, particularly in a confined space such as a hallway or landing, may be disorientating. Although it may seem drastic, removing them to create a more open-plan layout can reduce confusion and distress.

Possible Adaptations:

• Use of contrasting colours can assist with finding your way around the home and remembering what things are meant to be used for. For example, dark coloured bed linen against cream walls and carpet will really stand out, as would a dark coloured toilet seat or handrail against a white bathroom suite. Plain colours work better than patterns and you can use this idea to highlight any object you want easily noticed…light switches, cutlery on the table, door handles etc.
• Rearranging chairs to make it possible to look out of the window or watch what other people in the house are doing, can provide stimulation and help maintain social contact.
• Put away infrequently used items and try to keep cupboards and surfaces uncluttered so that the important, much used objects are easier to spot.
• Using see-through containers, glass fronted doors or open shelves will make things easier than having to remember where something is behind a closed cupboard door.

Lighting and Heating:

Hazards:

• Shadows and dark areas can increase the incidence of hallucinations so ensuring good lighting (whether natural and electric) without excessive brightness or shadow is important.
• Cookers and fires can become potential fire hazards as the dementia progresses. All fires should be fitted with a fire guard, and if possible, an isolation valve should be fitted to a gas fire or cooker to ensure it can only be turned on if a carer is there to supervise use.

 Possible Adaptations:

• Try to maximise natural daylight as this provides important information about the time of day.
• Timers and motion-sensitive sensors can be useful to ensure adequate lighting at night.
• Consider installing central heating with thermostatic controls that will automatically come on if the temperature drops below a certain level rather than having to rely on manual controls.

 Safety and Security:

Hazards:

• Minimize the risk of falls by installing handrails on stairs, grab rails on steps, and remove rugs or loose carpets that could prove a tripping danger.
• Fitting a KeySafe on to an outside wall enables the front door to be kept locked at all times. Relatives, friends and carers who know the KeySafe code can access the keys and still enter the property when needed.

 Possible Adaptations:

• Make sure a smoke alarm is fitted – preferably mains operated so you don’t need to worry about replacing batteries.
• Bathrooms can become a high accident risk area and hygiene needs to be a priority.

Colour coding important equipment such as grab rails, toothbrush, and even soap can help as a memory aid, and grab rails and a toilet riser can provide physical support. Many older people find using a bath difficult so it is worth considering fitting a level access shower or wet room. Getting this done as early as possible enables you to learn how to use it, helping maintain independence as long as possible, and then makes it easier for carers later on. Sensors can be fitted to the skirting boards so that if the taps are left running and cause a flood, the system will shut off the water and raise the alarm. Specially designed plugs are also available that drain water should a tap be left running.

• There is an ever growing range of equipment, gadgets and pressure-pad and motion sensors linked by a telephone line to a nominated person or call centre that can alert a carer to a potential problem.

Useful sources of information on the latest aids available, which can be accessed by clicking in the link below, are:

The Disabled Living Foundation’s website www.asksara.dlf.org.uk

ATDementia www.atdementia.org.uk

Assist UK www.assist-uk.org

Getting out and about with confidence

A diagnosis of dementia should not discourage anyone getting out and about in the early stages of the disease. Trips within the immediate neighbourhood provide a good source of exercise, relieve boredom and stress, ease aches and pains and provide opportunity for social engagement – all of which are vital in contributing to a feeling of general wellbeing and improved mood.

By putting in place a few simple precautions, much can be done to improve safety and alleviate fears of disorientation, confusion and getting lost.

1. Fit a KeySafe
A KeySafe is a small secure box fitted to the outside of the house in which you can keep a spare door key. The lock is activated by a 4 digit code. This can be useful if you go out and then realise you’ve forgotten your door key. Write down the number code and keep it in your purse or wallet so you’ve got it to refer to, and make sure someone nearby knows the code as well (perhaps a trusted neighbour or close friend you could ring should the need arise).

2. Consider external door sensors and reminder messages
Pressure pads can be fitted under the door mat, or on the bottom of the door itself, that can sound an alarm (to you, or via a telephone line to a nominated person or call centre) if the door is left open or play a pre-recorded and personalised message, reminding you to pick up your keys, put on a coat, remember your mobile phone, lock up etc.. as you go out. AT Dementia’s website shows some of the assistive technologies available and is recommended by the Alzheimer’s Society as a useful source of information – www.atdementia.org.uk

3. Carry a mobile phone or a tracking device
Having a simple mobile phone with a loved one’s phone number stored in it and easily accessible, can provide valuable reassurance, as can having location finder technology built into either your phone or a separate tracking device. This enables your location to be tracked on a computer or mobile phone by a friend or relative if you were expected home but appear to have gone missing. Most devices also have a panic button built-in should you become lost or disorientated.

4. Wear Identification
Some people carry an identification card containing details of their own name and address, and the phone number of someone who could be contacted should it become necessary. This information can also be contained in a wristband that can be worn all the time, alleviating worries about forgetting to take it with you. The Alzheimer’s Association recommend MedicAlert who provide an identification systems for adults where jewellery is engraved with details of the person’s condition, an ID number and a 24 hour emergency phone number – www.medicalert.org.uk

5. Use familiar local landmarks
Many people with dementia find that their recognition for familiar landmarks in the locality helps them find their way home safely. Following a familiar route that contains landmarks triggers deep memory. It may be helpful to photograph these landmarks then use these make a simple picture map tracing the route back from a place you visit often. The map reminding you of your way back from the local shop, may, for instance show photos of the hairdressers, followed by the café, the war memorial, then the street sign at the end of the road.

Getting out and about in the local area are important factors in maintaining a sense of purpose and wellbeing. Adopting these precautions will hopefully ease your own concerns, help reassure carers, and most importantly prolong independence for as long as possible.